The occurrence of low birth weight (<2,500 g) was more than twice that of normal controls (OR 2.1; CI 1.38 to 3.19; P <0.001). Although the rate of low birth weight in ulcerative colitis was not significant, there was a significant difference for infants born to mothers with Crohn's disease (OR 2.82; CI 1.42 to 5.60; P = 0.003).

Women with IBD were 1.5 times more likely to undergo a cesarean (CI 1.26 to 1.79; P<0.001), mainly those with Crohn's disease (OR 1.65; CI 1.19 to 2.29; P=0.003). Rates for women with ulcerative colitis, were not significantly different, however.

The overall IBD risk of congenital abnormalities was 2.37 times higher than that of the controls (CI 1.47 to 3.82; P < 0.001). However, that risk was significant for patients with ulcerative colitis versus controls (OR 3.88; CI 1.41 to 10.67; P= 0.009), but not for patients with Crohn's disease (P= 0.06).

No significant differences were found for rates of small-for- gestational-age infants or still births, the researchers reported.

Discussing the limitations of the study, the researchers said that physicians must base clinical decisions on observational studies that are vulnerable to bias and confounding variables. The studies included in the meta-analysis did not report on disease activity in relation to adverse outcomes.

However, they said, previous studies have suggested that if a woman conceives while her disease is active, she is more likely to have a premature infant or one with a low birthweight than a woman with quiescent disease.

The incidence of still births and spontaneous abortions is also related to disease activity, the researchers said. A prospective study reporting on adverse outcomes and the association with disease activity is still required.

Considering the possibility of an increase in adverse pregnancy outcomes with active disease, Dr. Tekkis's team wrote that "the management of pregnancy in patients with IBD needs to focus on maintaining disease remission before and during pregnancy."

Summing up, the researchers said that the surgeon and obstetricians need to discuss between themselves how to manage the delivery of women with IBD. Further studies are required to clarify which women are at higher risk, as it was not determined in this study, they said.

"A definitive study" they added, "is required to settle the issue of best management and from this a new set of guidelines to help both patients and their clinicians determine best practice".

Reviewed by Zalman S. Agus, MD Emeritus Professor at the University of Pennsylvania School of Medicine

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